ABSTRACT
Public participation has taken three forms which may be characterized in terms of the directness of involvement. First is an indirect subsidy—the exemption of certain medical care providers from United States (US) taxes, which often carries with it exemption from state and local sales and property taxes. Second are indirect and direct subsidies on the "demand side." Third, various governmental levels have provided medical care directly. This form includes local city or county hospitals and clinics through state general, mental, and tuberculosis hospitals and up to the Veterans' Administration hospital system and the medical care systems operated by the Department of Defense. Direct operation of medical care services in the US is substantial. The program's effects on medical care use have been dramatic. The major public program providing "insurance" against medical expenses is the Medicald program for low-income persons. Unlike Medicare, which is uniform for all states in the US, Medicald is a state-administered program financed by federal/state matching funds.
